Clinical Study Of Orthodontic Treatment Of Impacted Teeth

Objective:In this study,46 impacted teeth caused by various reasons were treated by surgical fenestration combined with orthodontic traction.the occurrence of embedded teeth before treatment and the changes of root length after treatment were observed,and the therapeutic effect was evaluated.Statistics on the success rate of traction,analysis of the relevant factors affecting the success rate of windowing traction.To explore the selection of clinical indications for windowing and traction of embedded teeth in orthodontic treatment and the location and timing of fenestration.The purpose of this study is to provide some basis for orthodontic treatment of embedded teeth.Methods:Patients with impacted teeth were randomly selected from January 2016 to January 2019 in the Department of Orthodontics,Yijishan Hospital,the first affiliated Hospital of Wannan Medical College.Patients with impacted teeth were diagnosed by curved tomography,CBCT and other imaging data(except the third molars).A total of 33 cases with 46 impacted teeth.The age at the first visit was between 8 and 25 years old,with an average of 13.6 years old.There were 15 male patients with an average age of 12.1 years,with a total of 22 impacted teeth,and 18 female patients with an average age of 14.9 years,with a total of 24 impacted teeth.There were 21 maxillary canines,17 maxillary central incisors,4 maxillary lateral incisors,1 maxillary second premolars,2 mandibular second premolars and 1 mandibular first premolars.The inclusion criteria of the samples were as follows: 1.The opposite side of the impacted teeth had germinated for more than six months;2.The teeth were completely embedded in the bone tissue and could not germinate on their own;3.X-ray showed that the apical foramen was closed,or the apical foramen was not closed,but the position of impacted teeth was abnormal and could not erupt normally;4.There was no history of severe periodontal disease and trauma.;5.After the patient’s signature,the patients were treated with fenestration and orthodontic traction;6.The ambushed teeth that can erupt by themselves after expanding the space are excluded.Before the start of treatment,full-mouth curved tomography and CBCT were taken,used mimics20.0 software to establish a three-dimensional digital model.The tooth position,degree of development,ambush depth and its relationship with adjacent tissues were observed.The method of surgical exposure combined with orthodontic traction was used.After the treatment,full-mouth curved tomography was taken routinely,the treatment effect was judged,and the success rate of impacted tooth traction was recorded.The factors affecting the success of impacted tooth traction and their correlation were analyzed.The criteria for determining the success of traction were as follows: the embedded teeth were pulled out completely,the root resorption was less than 1 stroke 3 of the root length,the pulp vitality was normal,the loosening degree was less than 2 mm,the gingival retraction did not exceed the root neck 1 stroke 3,there was no inflammatory reaction in the adjacent tissue,and there was no obvious absorption in the adjacent teeth.Failure to meet the above criteria is recorded as failure.Results:1.Among the cases in this study,the number of impacted teeth of maxillary canines was the most,accounting for 45.7% of the total number of impacted teeth,followed by the maxillary central incisors,accounting for 37%.Oblique impacted position was the most common among maxillary canines,accounting for 66.7% of the total number of impacted teeth of maxillary fangs;horizontal impacted position was the most common among maxillary central incisors,accounting for 47% of the total number of impacted teeth of maxillary central incisors.2.In this study,4 premolars were treated with closed traction through alveolar crest incision(extraction wound).Of the 42 anterior teeth,19 were treated with labial open traction,4 with labial closed traction and 19 with palatal open traction.After extraoral windowing orthodontic traction treatment,the traction results of 44 impacted teeth met the success criteria,and the other 2 teeth did not meet the success criteria and were identified as failure.Of the 10 impacted teeth in the apical closure group,2 failed and 8 were successful,of which 1 had mild root resorption(variation < 1 / 3 of the root length).In the apical unclosed group,36 teeth were distracted successfully and there was no obvious root resorption.Of the 3 curved root impacted teeth,2 were successfully distracted and 1 failed.The recovery of gingival shape was observed,the effect of alveolar crest closed traction was the best,and the gingival shape of labial open traction was not good.3.SPSS software was used to analyze whether there were differences in traction success rates between different ages,genders,window positions,and degree of root development.The results showed that the apical foramen closed group had a higher traction success rate than the closed group,The test results showed that there was significant difference(P < 0.05).Conclusion:1.Extraoral windowing assisted orthodontic traction is significantly effective in the treatment of impacted teeth in various positions,and careful traction is needed for patients with horizontal low impacted teeth with multiple impacted teeth and inverted impacted teeth.2.The success rate of traction in the apical unclosed group is higher than that in the closed group,and the undeveloped root is a favorable factor for the successful traction of impacted teeth,and for the impacted teeth with curved root,traction treatment in the early stage of root development is beneficial to the completion of root development in the normal position.3.Except for the third molars and supernumerary teeth,the impacted maxillary canines are the most common in the normal position,in which the oblique impacted maxillary canines are the most common,followed by the impacted maxillary central incisors,among which the horizontal impacted maxillary central incisors are the most common.